深静脉长期留置导管在维持性血液透析患者中的临床应用

Clinical study on dialysis adequacy and complications using long-term indwelling cuffed tunneled catheter for blood access in maintenance hemodialysis patients

目的比较以深静脉长期留置导管(导管组)与动静脉内瘘(内瘘组)为血管通路的血液透析患者营养状况、透析充分性及并发症的差异,探讨深静脉长期留置导管在维持性血液透析患者的临床意义。方法选择海军总医院肾脏病科2006年7月至2007年7月新建立导管组透析患者39例,新建立内瘘组透析患者40例,血管通路均使用3个月以上,随访36～48个月,观察2组透析患者入组年龄、最大血流量及观察终点前一月内每周红细胞生成素总量、射血分数(ejection fraction,EF)、透析前实验室指标、尿素清除率(Kt/V)、尿素下降率(urea reduction ratio,URR),以及观察期间2组感染、血栓、死亡发生情况,并进行比较。结果导管使用时间(21.5±7.7)月,内瘘使用时间(29.8±10.3)月,导管组与内瘘组患者比较,实验室检测指标间差异均无统计学意义(均P>0.05),内瘘组透析患者最大血流量、通路使用时间、Kt/V、URR、EF均显著高于导管组(均P<0.05),导管组感染率、血栓发生率及病死率均显著高于内瘘组(均P<0.05)。结论导管组与内瘘组患者营养状况相当,均可达到充分透析,尽管导管组血液透析患者有更高的感染率和血栓发生率,深静脉长期留置导管仍为维持性透析患者建立血管通路的极好补充形式。

Objective To compare dialysis adequacy and complications between hemodialysis patients using cuffed tunneled catheter（CTC） and those using arteriovenous fistula for blood access,and to find out a relatively ideal vascular access approach.Methods Patients subjected to an operation of long-term hemodialysis access between July 2006 and July 2007 were enrolled in this study.Dialysis adequacy and complications after the operation were compared in patients using vascular access of arteriovenous fistula（AVF）（n=40） and those using CTC in an internal jugular vein（n=39） in a follow-up period of 36～48 months.Results The duration of using AVF and CTC for blood access was 29.75±10.26 months and 21.48±7.74 months,respectively.Laboratory variables were indifferent between the two groups（P〉0.05）,except serum phosphorus.Maximal blood flow,blood access usage duration,Kt/V,urea reduction ratio and EF were significantly higher in patients using AVF than in those using CTC（P〈0.05）.The prevalence of catheter infection,thrombus and death were significantly higher in patients using CTC group（P〈0.05）.Conclusions Although the prevalence of adverse events was higher in patients using CTC,they still obtained the same dialysis adequacy as those using AVF.CTC is an optimal and alternative vascular access for maintenance hemodialysis patients.